HomeMy WebLinkAboutBuilding Permit ApplicationI
All APPLICABLE INFO MUST BE COMPCertD FOR APPLICATION TO BE ACCEPTED j J
Date: .,2 • 5• 17 Permit Number: 1 �l a' o /a
R
Y
Building Permit Application DEC / 5 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: den -,I
+ V't S
'ROVEMENT LOCATION a
Address: Address: 5 ,.
Legal Description:
Property Tax ID #: b�-' (plO - 0 () CO, - 060 Lot No. l
Site Plan Name: v S� e S Block No.13
Project Name: .� vu 0edCs4le,5
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK. ors. s w rti Cyr► et-2 ,. .
6
CONSTRUCTION 1N'FORiVIATION
. s , _ s
Additiona worK to be per orme un er,t is permit - check all that app y.
_Mechanical _ Gas Tank _ Gas Piping /_ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: a- 40 9� Sq. Ft. of First Floor:
ry J
Cost of Construction: $ V 'n � ��% Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
� 'CONTRACTOR::
Name AP + e
Name: 19 � bl.-
Address: loS's 10 SR P.UC& �0 -
Company: �1i4L���I L"�&I
Address: ��.s(010e.h
City: l (�+V-4c'? State:
City: (ryeClAn 10e-e State: f-(
Zip Code: 91g i S 3 Fax:
Phone No. be `� i �' 0
Zip Code: 9'45 9 LJ Fax:
E-Mail:
�7
Phone No /7� J� ��o� oy1 r7ar�5
E-Mail AR J1J<eJl e 10dJ1SC LA. e/y`e ,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License Cgc 0-S 5l S-S—
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
FEE SIMPLE TITLE HOLDER: (ifQot Applicable
Name:
Address:
City:I
Zip: Phone:
I
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is -granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applicationsare exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure;to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or record our Notice of Commencement.
Xor/LUieeqase%rHH,,
Signature of Owner se , —otr--acto.&aas�Agent`for Owne
Signature of
STATE OF FLOR
COUNTY OF'R�_ ' r l
STATE OF FLO
COUNTY OF
;o
The forgoing instrument was acknowledged before a
�1
The forgoing instr ent was acknowledged before
C' C
me o
this � day of Z> e- y- 12017 by � W �
this day of 20a• by
m�
I l a
ell e s
a
e m t
1
6 U/
Name Lemaking statement. a s w
�; �
Name of person making statement.Personn
y
II
OR Produced Identificat
Perso Known OR Produced Identificati
Type oion I ro a Q
Produced �N
Type of Iden cation
Produced
�� c
H ^'
I
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
I
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
;,,REVIEW
DATE
RECEIVED
DATE
I
COMPLETED
Rev. 8/2/17